How a neurologist stays sharp

The human brain is the most complex collection of matter in the known universe. It is a biological computer with functions so intricate that even basic tasks like memory storage and retrieval are still not entirely understood. Even though we have much to learn about how this machine works, there are many things we can do to optimize its function, prevent wear and tear, and in some cases reverse damage. Each topic below will be discussed in more detail in future posts, but here is a general overview that you may find helpful. Remember to discuss all health advice with your doctor before implementing:

Get good quality sleep: I’m including this first because in my opinion, sleep is the most overlooked and easily modifiable factor in improving brain health. Sleep is essential for proper brain function. Per the National Sleep Foundation, if you’re between 18-64 you should get 7 to 9 hours per night, and if you’re 65+ you should get 7 to 8 hours per night. Practices to optimize your sleep (known as sleep hygiene) include making sure your bedroom is cool, dark, and quiet; avoiding big meals right before bed, but also making sure you don’t go to sleep hungry; avoiding screens/bright lights before bed and also in the middle of the night if you wake up; getting exposure to bright light when you wake up in the morning (ideally go for a brief walk and get some sun exposure); avoiding alcohol prior to sleep; avoiding caffeine after noon; if you have difficulty falling asleep, going into another room and reading a relaxing book (or doing another relaxing activity such as writing or meditating), then trying again when you become sleepier; not using your bed for any activities other than sleep and sex (you want to train your brain to associate the bed with only those activities, so when you get inside you naturally become more tired); avoiding strenuous exercise before sleep, though trying to exercise each day; keeping a notepad next to your bed, and if you have any worries/thoughts/ideas that pop up as you try to fall asleep, write them down and rest assured that you can address those items the next day; having the same bedtime and wake time every day, including the weekends. If you adhere to these practices and the quality of your sleep is not improved within a few weeks, then I recommend discussing with your doctor and considering evaluation by a sleep specialist (often a neurologist or lung specialist). They may end up diagnosing sleep disorders such as such as obstructive sleep apnea which can be easily treated. A future post will go into more detail about improving sleep, but these are good first steps which should work for most people.

Diet/supplements: The diet with the best evidence to support brain health is the Mediterranean diet. Generally this diet consists of mostly vegetables/fruits, nuts/seeds, whole grains, healthy oils such as olive oil, small or medium quantities of fish/poultry/dairy, low quantities of red meat, and avoidance of processed foods. Regarding supplements, as long as you have a well-balanced diet you likely don’t need additional supplementation. There are plenty of substances on the market with wild claims of improving cognition, but there is no convincing evidence that any of them work. Some may even be harmful. Be sure to discuss your diet with your doctor, and don’t start taking any supplements without discussing with your doctor first.

Medications: Many medications have side effects which can contribute to fatigue, brain fog, and memory impairment. As more and more medications are prescribed as we get older, it’s easy for side effects to amplify. Even with no recent medication or dosage changes, the clearance of medication from your body may be affected as you get older, resulting in stronger side effects as you age. It’s important to talk with your doctors about every medication you take, and any medications which are taken chronically should be re-evaluated to determine if they are still necessary or if the dose should be changed.

Medical factors: Many medical problems can impact brain health, so it’s very important to properly manage conditions such as high blood pressure, diabetes, and excess weight. Problems with other organs such as the liver, kidneys, gastrointestinal system, and the heart/lungs can also impact brain function. For example, a patient complaining of brain fog may actually have a very healthy brain, but a liver or kidney problem may lead to the accumulation of metabolic byproducts which can impair brain function. This is why it’s very important to have at least annual follow-up with your primary care doctor: if you want to improve the function of your brain, all the other things happening below the neck should be optimized!

Exercise: Most people should aim for moderate physical activity at least 3 or more days per week, totaling at least 150 minutes per week. Regarding what to do, the best program is the one you stick with. It should be enjoyable, and it should be easy to incorporate into your daily life. Before starting any new fitness program, be sure to discuss with your doctor first.

Brain games: There are many products on the market claiming to improve cognition by playing “brain games” or performing cognitively demanding tasks. Unfortunately, there is no product on the market currently with proven long-term benefit for dementia prevention. However, just because this hasn’t been proven yet doesn’t mean that such activities have no benefit. All learning, creative thinking, and problem solving involves the interactions of billions of brain cells performing trillions of calculations per second. Exercising these neural pathways makes them stronger. The best exercises (as mentioned above) are the ones that you will stick with. Whether it’s doing crosswords, reading books, playing chess, or even playing video games (many are actually extremely complex and require very high levels of critical thinking and problem solving to get through), find something that you enjoy, and stick with it!

Being social: Regular social interactions are important for psychological health, and psychological health is also brain health. For younger people who are still in the workforce, it’s possible to feel isolated even after spending the whole day surrounded by people. Feelings of isolation are also very common after retirement, and opportunities for social interactions may be significantly more limited because of health and/or mobility problems. Often it takes effort to find enjoyable social experiences, but this effort is worth it. Some people need assistance with this, so if you have any family or friends who seem isolated, please reach out! Many cases of cognitive problems end up being undiagnosed or untreated depression, and loneliness can contribute to this or even be caused by it. Remember that it’s important to discuss your mood and other psychological symptoms with your doctor at least once per year or sooner if there are any changes.

Smoking/drugs/alcohol: Smoking: don’t do it. Recreational drugs: don’t use them. Alcohol: possibly ok in moderation (no more than 2 drinks per day if you’re a man, no more than 1 drink per day if you’re a non-pregnant woman, and at least one day per week with no drinking; for men and women 65+: 1 or fewer drinks per day, and at least one day per week with no drinking). Some experts advise no alcohol consumption at all, though some studies suggest a possible cardiovascular protective effect from mild/moderate alcohol consumption. If you don’t already enjoy drinking, I wouldn’t do it just for the sake of possibly improving your cardiovascular health. If you do enjoy drinking, just be sure it’s no more than moderate.

Again, make sure to have at least annual follow-up with your primary care doctor to discuss all of the topics above, and if you have any concerns about your brain health, make an appointment with a neurologist. See you in the next post!